Healthcare Provider Details

I. General information

NPI: 1073216958
Provider Name (Legal Business Name): NICO ESPINAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44344 DEQUINDRE RD
STERLING HEIGHTS MI
48314-1038
US

IV. Provider business mailing address

44344 DEQUINDRE RD
STERLING HEIGHTS MI
48314-1038
US

V. Phone/Fax

Practice location:
  • Phone: 586-323-6300
  • Fax:
Mailing address:
  • Phone: 586-323-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301517077
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: